It’s a familiar story I hear from parents. My teenager’s room is a wreck. There’s laundry everywhere, dishes under the bed, and she can never seem to find anything. She’s having trouble keeping track of assignments, always procrastinates, and can’t focus in class. High school has been a rough transition.
Does this teen have attention-deficit/hyperactivity disorder (ADHD)? Or is she still figuring out how to organize, plan ahead, and manage stress? The answer is not always clear-cut. Teens and adults can be diagnosed with ADHD even if they were not diagnosed as children. However, there are many other explanations for these types of symptoms in teens, including anxiety, depression, and learning disabilities. Also, it is entirely possible this teen might be exhibiting typical adolescent behavior.
Getting an accurate diagnosis is key to understanding whether or not your teen actually has ADHD, and the type of support, strategies, and intervention that will be most helpful if she does.
It’s a Complicated Diagnosis in Teens
First, it’s important to understand the diagnosis of ADHD. Health professionals use the criteria in Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to determine if an individual’s symptoms are consistent with ADHD. There are three kinds of ADHD: primarily hyperactive-impulsive, primarily inattentive, and combined type. What used to be known as ADD is now known as ADHD-primarily inattentive type. Individuals with ADHD-primarily inattentive type only have the inattentive symptoms of ADHD (difficulty paying attention, staying organized, and remembering things). They do not have the symptoms of hyperactivity and impulsivity (difficulty remaining still, constant fidgeting, and talking too much). Often, individuals with ADHD-primarily inattentive type,
especially females, go undiagnosed with ADHD as children. These individuals do not fit the classic stereotype of an ADHD child – the child who runs around the classroom, climbs on top of the refrigerator, interrupts everyone, and just like the Energizer bunny, keeps going and going and going.
What Does ADHD Look Like in Teens?
One of the challenges with diagnosing ADHD in teens is the symptoms often look different than they do in younger children. It is not uncommon for teens and adults with ADHD to have more challenges with inattention than hyperactivity and impulsivity. Many individuals who exhibited combined symptoms of inattention, hyperactivity, and impulsivity during childhood find that their hyperactivity becomes less obvious as they get older. Sometimes the hyperactive and impulsive symptoms of ADHD were present when the individual was younger, and sometimes, the hyperactive and impulsive symptoms were never clearly there at all (as in ADHD- primarily inattentive type). In either of these scenarios, the individual might still have a diagnosis of ADHD.
Here are some examples of how ADHD symptoms can differ in teens versus children:
• Teens with ADHD often have difficulties with hyperactivity, but unlike children, they are not bouncing off the walls or climbing on top of furniture. In teens, hyperactivity might mean constant leg jostling, fidgeting with everything, talking incessantly, and jumping from one task to another without finishing.
• Teens with ADHD can have difficulties with impulsivity. They might be quick to send a text without thinking, offend others easily because they have no filter, and be more susceptible to peer pressure. Teens with ADHD are more likely to make risky decisions when it comes to things like driving, substance use, and sexual activity. In addition, teens are at a developmental stage where they are more self-aware and care more about approval from peers. This is very different from the carefree ADHD child who hardly paid attention to what anyone thought of him.
• Teens with ADHD sometimes struggle in school in ways they did not when they were younger and had more support from teachers and parents. As students get older, classes get harder, more independence is expected, and schedules are increasingly complicated with block scheduling, afterschool activities, and a social life to juggle.
• Teens with ADHD often have difficulties regulating emotions. The individual with ADHD who threw epic tantrums as a child may become a teen who struggles with calming down and thinking things through. He can experience emotions more intensely, be impatient and easily frustrated, and be quick to react and lash out without thinking.
To properly diagnose ADHD in teens, it’s crucial to consider what symptoms have been present over the course of time, across different settings, and to look at these things from multiple perspectives. Without an understanding of these things, ADHD can easily be misdiagnosed.
Obtaining a reliable report of current and past ADHD symptoms in teens can be difficult. Parents are asked to think back to what the child was like during childhood, the details of which are sometimes hard to remember.
In terms of gathering multiple perspectives, some symptoms of ADHD in teenagers are less easily observed by an outsider. Additionally, high school teachers (or college professors) do not always know students as well because they only have them for one class. It is still important and necessary to get the perspective of multiple individuals, including the teen’s point of view.
It is also crucial to consider other diagnoses such as anxiety, depression, a learning disability or the use of substances that can result in symptoms that overlap with those seen in ADHD (like fidgety behavior, restlessness, difficulty concentrating). It is possible, and in fact common, for someone to have ADHD as well as another diagnosis. A thorough psychological assessment helps to tease apart whether an individual has ADHD, another diagnosis, or both. Additionally, a physical examination can be important to rule out other causes for symptoms, such as hearing or vision changes, sleep disorders, or a sports-related brain injury.
What to Expect at an Evaluation and Beyond
A comprehensive evaluation for ADHD typically involves a clinical interview with the teen and parents, standardized rating forms completed by teachers, parents, and the teen, and often, an assessment of cognitive abilities and executive functioning skills. The professional will gather information about developmental, medical, and family history, and emotional and behavioral symptoms related to home life, social interactions, and school.
After an evaluation, there are different treatment options to consider, including stimulant and non-stimulant medication, behavioral interventions, and school accommodations through a 504 or individualized education program (IEP). Behavioral interventions are often focused on parent-teen communication, problem-solving, behavior management, organization and planning, or coping skills for managing ADHD and other co-occurring concerns like anxiety
or emotion regulation.
If your teen is prescribed medication for ADHD, it is important to discuss drug safety. When properly prescribed and taken, medications for treating ADHD are safe and effective. However, ADHD medications can also be abused. Medication should only be taken by the person for whom it has been prescribed for the intended purpose, and never shared or sold. Talk to your teen about the legal and health consequences of sharing or selling medication and the importance of safeguarding it from theft. Regardless of what treatment approach is used, accurate education and discussion about ADHD, what it means for your teen, and what treatment options exist are important.
If you, your teen, or your teen’s teachers suspect your teen might have undiagnosed ADHD, it is important to seek an evaluation. You can start by talking with your teen’s school and/or your teen’s pediatrician. A psychologist, psychiatrist, or pediatrician can diagnose ADHD, and parents should know that it is never too late to seek an evaluation for your teen.